Clinical outcomes after catheter-directed therapies for pulmonary embolism in a regional hub-and-spoke system: lessons learned from a real-world experience.

The study cohort consisted of 90 intermediate-high or high-risk PE patients treated with catheter-directed therapies following introduction of a centralized PE response team.

• 71 patients (78.9%) underwent ultrasound-assisted catheter-directed thrombolysis (USAT)
• 17 patients (18.9%) underwent large-bore mechanical thrombectomy (LBMT)
• 2 patients (2.2%) received both interventional strategies
• Median age was 72.0 (60.8-78.2) years and 52.2% were female patients

Patients presented with significant baseline right-ventricular impairment as evidenced by echocardiography and laboratory values.

• Baseline right-ventricular/left-ventricular (RV/LV) ratio was 1.2 ± 0.2
• Elevated median high-sensitive troponin T of 63.0 (37.0-120.0) ng/l
• Elevated median NT-pro-BNP of 2054.5 (538.2-5936.0) pg/ml

RV/LV ratio was normalized to ≤1.0 in 58.2% of cases before hospital discharge.

• Normalization defined as RV/LV ratio ≤1.0
• Assessment performed prior to hospital discharge
• Reflects hemodynamic improvement following pharmacomechanical intervention

In-hospital mortality occurred in 5 patients (5.6%) during the study period.

• 5 out of 90 patients died in hospital
• In-hospital mortality rate was 5.6%
• Study was a retrospective analysis of the first 90 patients treated in the regional system

Bleeding complications occurred in 12 patients (13.5%), including one fatal intracranial hemorrhage.

• 12 of 90 patients experienced bleeding complications
• Overall bleeding complication rate was 13.5%
• One patient experienced a fatal intracranial hemorrhage
• Authors described this as a 'nonnegligible complication rate'

The study was conducted within a regional hub-and-spoke system following the introduction of a centralized PE response team.

• Retrospective analysis design
• Represented the first 90 patients treated under the new system
• The centralized PE response team coordinated care across the hub-and-spoke regional network
• Authors concluded that optimization of technical aspects and patient selection is necessary